Provider Demographics
NPI:1659581890
Name:SPILLANE, HEATHER (LAC MS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SPILLANE
Suffix:
Gender:F
Credentials:LAC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1697 BROADWAY STE 900
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5907
Mailing Address - Country:US
Mailing Address - Phone:646-369-4433
Mailing Address - Fax:646-861-1882
Practice Address - Street 1:1697 BROADWAY STE 900
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5907
Practice Address - Country:US
Practice Address - Phone:646-369-4433
Practice Address - Fax:646-861-1882
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002430171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist